New Mexico ranks in nation's top 5 for generic prescriptions

New study shows Medicare

Editor's note: This is an ongoing look at wasteful spending in Medicare's massive drug program.

LAS CRUCES >> When it comes to prescribing generic drugs over often-pricey name-brand medication to Medicare Part D patients, new research indicates that New Mexico is among the top in the nation.

With roughly 1 billion claims made in the U.S. in 2011 -- the most recent data available -- 77.1 percent of the claims filled were for generic prescriptions, according to information from ProPublica, which analyzed the program's prescription data obtained through the Freedom of Information Act. About 5.5 million of the total claims came from New Mexico, where doctors prescribed an average of 80.7 percent generic drugs as part of Medicare Part D, a federal program to subsidize the costs of prescription drugs for Medicare beneficiaries in the U.S. since 2006.

Nevada, at 81.4 percent, is top in the nation for writing prescriptions for generic brand drugs, followed by Minnesota (81.1 percent), Oregon (80.8 percent), New Mexico and Iowa (80.4 percent), according to the recently released data.

"The most important thing is that it is a very rare situation where a brand name is prescribed when its generic equivalent is available and is the same medication and works the same way," said Dr. Kathleen Hales, who has worked in family medicine at Memorial Medical Center in Las Cruces for 8 1/2 years.

"New Mexico is a poor state and most providers look at prescription medication patients can afford, and will take," she said.

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According to the ProPublica data, the prescription of medication to Part D patients adds up to $77.7 billion in the U.S. in 2011, with $374 million of that being prescribed in New Mexico.

Hales said that with formularies -- a list of medicine -- at the state's military instillations, most large hospitals, nursing homes and large federally funded health clinics, name-brand medications are generally substituted for the cheaper and just-as-effective generic alternative, unless explicitly requested by the doctor. Insurance companies will also make these changes, she said.

Robin Zielinski Sun-News
Pictured are two medications, on the left is Levothyroxine sodium tablets, and its generic form Synthroid is on the right

But in New Mexico, having access to the generic prescription seems to begin with the provider.

"It's because people (in New Mexico) are poor," said Sylvia Dipace, eligibility specialist with La Clinica de Familia in Doña Ana County.

LCDF provides health and social service programs that are funded through federal, state and city government as well as local foundations and organizations.

"Most doctors are compassionate to clients," she added. "I think New Mexico is a good place to be in as far as health care, there are a lot of benefits."

Hales said the policy for doctors at Memorial Medical Center is to try to prescribe medication that is included on Walmart's $4 Prescription Program list, which includes hundreds of generic drugs and over-the-counter medications that cost only $4 for a 30-day supply.

Brand-name industry

While New Mexico is a the forefront of providing affordable generic prescriptions, research indicates that some state doctors were still paid for working with brand-name drug industries in a variety of capacities.

Out of $2.1 billion in disclosed payments, ProPublica, in a separate research piece called "Dollars for Docs," found that Dr. Douglas Maple, in Albuquerque, received the most payments made to practitioners and institutions in the state in 2011 when he received $626,400 from United Kingdom-based GlaxoSmithKline for research.

According to ProPublica, in July 2012, GlaxoSmithKline agreed to plead guilty and pay $3 billion to settle criminal charges and civil claims related to its "unlawful promotion of certain prescription drugs, its failure to report certain safety data and its civil liability for alleged false price-reporting practices," according to the U.S. Justice Department.

Over the span of the "Dollars for Docs" research (from 2009 to 2012), name-brand drug companies paid New Mexico practitioners and institutions a total of $7.1 million for services like research, speaking, travel and consulting.

Hales said that, with one medical school in the state at the University of New Mexico in Albuquerque, they are more likely to receive grants for research.

"Whether or not they prescribe them (the name brand-drug) is up to the individual," she said.

As for the rest of the state, Hales said, there is more resistance to drug industry representatives pushing for brand-name medication.

Toting around and passing out sample medications, pens and coffee mugs depicting their logo, Hales said drug company representatives assume that, after seeing their logo so much, doctors will begin to prescribe their medication.

"But most health clinics, government institutions and hospital clinics, including Memorial Medical Center don't allow drug-industry representatives to talk to providers or leave their merchandise at the hospital without it being thrown away," she said.

Instead, Hales said, providers find out about new drugs through scientific comparison in peer-reviewed journals.

"If it's not better or safer or cheaper, then we don't need it to clutter our brains," she said.

According to "Dollars for Docs," California received the most money from name-brand drug companies at $245.4 million during the four years.

Exceptions to the rule

However, not all medical issues can be helped by the use of generic medication.

"I have one patient who needs one specific brand; one formula of medication in order to keep stable," Hales said. "Those situations are rare."

Dipace also has experience with the necessity of certain name-brand drugs.

She has had a brain tumor since 2011 and is on the prescription drug Cymbalta for chronic headaches and pain. Even with insurance, Dipace said the medication is still $75 for a 30-day supply.

"I get help from insurance, but I have to take it out of my budget," she said. "If there was a generic for it, I would jump on it."

The top prescription in New Mexico, according to ProPublica, is Lisinopril, a generic drug which treats high blood pressure and heart failure. There were a total of 258,611 claims made for the drug in 2011, at a total cost of around $2.7 million. The top medication in the nation during the same time was Simvastatin, also a generic prescription, which treats high cholesterol and triglyceride levels in the blood. There were 40.9 million claims, at a cost of around $594 million nationally.

NM's top prescribers

Unlike the majority of states in the U.S., New Mexico has no outliers -- doctors who prescribe in ways unlike most of their peers -- but some doctors do receive a higher number of medication claims than others.

According to the data, Dr. Henry Middleton of Albuquerque received the most claims in 2011 at 50,420 from about 1,400 Medicare Part D patients. Prescribing 81 percent generic drugs, the total cost was roughly $2.96 million for that year.

Immediately behind Middleton was Dr. Roland Sanchez of Belen, with 27,000 claims from about 1,300 patients. According to the data, Sanchez prescribed 83 percent generic medication.

Probably the most outstanding doctor in prescribing generic medication at such a high volume was Dr. Lucas Casul, of Albuquerque, who prescribed 85 percent generic drugs for a total of $65 for 393 patients. According to ProPublica, the average price of a prescription from Casul was $0, compared to $58 per prescription from his peers in the rest of the state.

To be included in ProPublica's research, a provider had to write 50 or more prescriptions for at least one drug in Medicare Part D in 2011. Medications provided at an office visit or hospital aren't included because they are covered by other parts of Medicare. Prescriptions also are not included for Medicare enrollees covered through employers, the Veterans Health Administration or some retiree health plans.

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